Sonography to rule out tuberculosis in sub-Saharan Africa: a prospective observational study

Ndege, Robert and Weisser, Maja and Elzi, Luigia and Diggelmann, Flavia and Bani, Farida and Gingo, Winfrid and Sikalengo, George and Mapesi, Herry and Mchomvu, Elisante and Kamwela, Lujeko and Mnzava, Dorcas and Battegay, Manuel and Reither, Klaus and Paris, Daniel H. and Rohacek, Martin. (2019) Sonography to rule out tuberculosis in sub-Saharan Africa: a prospective observational study. Open forum infectious diseases, 6 (4). ofz154.

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Patients with suspected tuberculosis are often overtreated with antituberculosis drugs. We evaluated the diagnostic value of the focused assessment with sonography for HIV-associated tuberculosis (FASH) in rural Tanzania.; In a prospective cohort study, the frequency of FASH signs was compared between patients with confirmed tuberculosis and those without tuberculosis. Clinical and laboratory examination, chest x-ray, Xpert MTB/RIF assay, and culture from sputum, sterile body fluids, lymph node aspirates, and Xpert MTB/RIF urine assay was done.; Of 191 analyzed patients with a 6-month follow-up, 52.4% tested positive for human immunodeficiency virus, 21.5% had clinically suspected pulmonary tuberculosis, 3.7% had extrapulmonary tuberculosis, and 74.9% had extrapulmonary and pulmonary tuberculosis. Tuberculosis was microbiologically confirmed in 57.6%, probable in 13.1%, and excluded in 29.3%. Ten of eleven patients with splenic or hepatic hypoechogenic lesions had confirmed tuberculosis. In a univariate model, abdominal lymphadenopathy was significantly associated with confirmed tuberculosis. Pleural- and pericardial effusion, ascites, and thickened ileum wall lacked significant association. In a multiple regression model, abnormal chest x-ray (odds ratio [OR] = 6.19; 95% confidence interval [CI], 1.96-19.6;; P; &lt; .002), ≥1 FASH-sign (OR = 3.33; 95% CI, 1.21-9.12;; P; = .019), and body temperature (OR = 2.48; 95% CI, 1.52-5.03;; P; = .001 per °C increase) remained associated with tuberculosis. A combination of ≥1 FASH sign, abnormal chest x-ray, and temperature ≥37.5°C had 99.1% sensitivity (95% CI, 94.9-99.9), 35.2% specificity (95% CI, 22.7-49.4), and a positive and negative predictive value of 75.2% (95% CI, 71.3-78.7) and 95.0% (95% CI, 72.3-99.3).; The absence of FASH signs combined with a normal chest x-ray and body temperature <37.5°C might exclude tuberculosis.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medicine (MED) > Clinical Research (Reither)
UniBasel Contributors:Weisser, Maja and Reither, Klaus and Paris, Daniel Henry and Rohacek, Martin
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Oxford University Press
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:14 May 2019 09:33
Deposited On:14 May 2019 09:32

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